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使用扁平软组织移植物进行后交叉韧带重建

Posterior Cruciate Ligament Reconstruction Using Flat Soft-Tissue Grafts.

作者信息

Fink Christian, Farinelli Luca, Abermann Elisabeth, Meena Amit, Smigielski Robert, Herbort Mirco

机构信息

Gelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria.

Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), ISAG, UMIT Hall, Hall in Tirol, Austria.

出版信息

Arthrosc Tech. 2023 Jan 18;12(2):e261-e271. doi: 10.1016/j.eats.2022.10.016. eCollection 2023 Feb.

DOI:10.1016/j.eats.2022.10.016
PMID:36879862
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9984795/
Abstract

Isolated posterior cruciate ligament (PCL) ruptures are relatively rare, but they more commonly occur in multiligament knee injuries. To date, in isolated or combined injuries with grade III step-off, surgical treatment is recommended to restore joint stability and improve knee function. Several techniques for PCL reconstruction have been described. However, recent evidence has suggested that broad, flat soft-tissue grafts may more closely mimic the native PCL ribbonlike morphology in PCL reconstruction. Furthermore, a femoral rectangular bone tunnel may more accurately re-create the native PCL attachment, allowing grafts to simulate native PCL rotation during knee flexion and potentially improving biomechanics. Therefore, we have developed a PCL reconstruction technique using flat quadriceps or hamstring grafts. This technique can be performed using 2 types of surgical instruments that allow for the creation of a rectangular femoral bone tunnel.

摘要

单纯后交叉韧带（PCL）断裂相对少见，但更常见于膝关节多韧带损伤中。迄今为止，对于伴有III级台阶样移位的单纯或合并损伤，建议进行手术治疗以恢复关节稳定性并改善膝关节功能。已有多种PCL重建技术被描述。然而，最近的证据表明，在PCL重建中，宽而扁平的软组织移植物可能更接近天然PCL的带状形态。此外，股骨矩形骨隧道可能更准确地重建天然PCL附着点，使移植物在膝关节屈曲时模拟天然PCL的旋转，并有可能改善生物力学性能。因此，我们开发了一种使用扁平股四头肌或腘绳肌移植物的PCL重建技术。该技术可使用两种手术器械来创建股骨矩形骨隧道。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/aeb2fcee9394/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/0973f8cc2bd7/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/866194f4234c/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/df2dbf5884a5/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/1b11f2a934f8/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/5cbaf17f156b/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/cd7bdea4e097/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/fe32aff8a96c/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/de598ba03f78/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/1d6ff8126e34/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/aeb2fcee9394/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/0973f8cc2bd7/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/866194f4234c/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/df2dbf5884a5/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/1b11f2a934f8/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/5cbaf17f156b/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/cd7bdea4e097/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/fe32aff8a96c/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/de598ba03f78/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/1d6ff8126e34/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c8/9984795/aeb2fcee9394/gr10.jpg

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本文引用的文献

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2
Minimally Invasive Quadriceps Tendon Single-Bundle, Arthroscopic, Anatomic Anterior Cruciate Ligament Reconstruction With Rectangular Bone Tunnels.微创股四头肌肌腱单束、关节镜下、采用矩形骨隧道的解剖学前交叉韧带重建术
Arthrosc Tech. 2018 Sep 24;7(10):e1045-e1056. doi: 10.1016/j.eats.2018.06.012. eCollection 2018 Oct.
3
Anatomic is better than isometric posterior cruciate ligament tunnel placement based upon in vivo simulation.
基于体内模拟，解剖定位优于等长后交叉韧带隧道定位。
Knee Surg Sports Traumatol Arthrosc. 2019 Aug;27(8):2440-2449. doi: 10.1007/s00167-018-5233-7. Epub 2018 Oct 26.
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Posterior Cruciate Ligament: Current Concepts Review.后交叉韧带：当前概念综述
Arch Bone Jt Surg. 2018 Jan;6(1):8-18.
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Posterior cruciate ligament is twisted and flat structure: new prospective on anatomical morphology.后交叉韧带呈扭曲扁平结构：解剖形态学新视角。
Knee Surg Sports Traumatol Arthrosc. 2018 Jan;26(1):31-39. doi: 10.1007/s00167-017-4634-3. Epub 2017 Jul 15.
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Minimally invasive harvest of a quadriceps tendon graft with or without a bone block.带或不带骨块的股四头肌肌腱移植物的微创获取
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Ribbon like appearance of the midsubstance fibres of the anterior cruciate ligament close to its femoral insertion site: a cadaveric study including 111 knees.前交叉韧带股骨止点处中体纤维呈束状外观：一项包括 111 例膝关节的尸体研究。
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